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Oral Pathology Exam 1 > 6 Viral Infections > Flashcards

6 Viral Infections Flashcards

1
Q
  • a family of DNA viruses that affect humans exclusively
  • endemic worldwide
  • potential lifeline infection
  • 8 different types
A

human herpesviruses

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2
Q

How do herpesviruses have the potential to be lifelong?

A

primary infection –> latency of the virus within specific cells –> ability to undergo reactivation

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3
Q

Compare/contrast HSV-1 and HSV-2

A

HSV-1

  • tends to affect the oral, facial, and ocular regions
  • spread through infected saliva or active lesions

HSV-2

  • tends to affect the genital mucosa
  • spread through sexual contact

Both

  • structurally similar (50% DNA sequence homology)
  • different epidemiology
  • both types infect epithelial cells then establish latency in nerve ganglia
  • clinical lesions appear the same, but different anatomic pattern distribution
  • rarely, HSV-1 can cause a HSV-2-like anatomic pattern of infection (and vice versa)
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4
Q

How can being infected with HSV-1 help reduce the change of being infected by HSV-2?

A

antibodies directed against one type can cross-react with the other type

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5
Q

HSV-1: primary infection –> latency –> recurrent infection

A

Primary infection- often (but not always) asymptomatic

Latency- the trigeminal ganglion is the most common site of latency

Recurrent infection- asymptomatic viral shedding in the saliva (common), symptomatic recurrent infections (herpes labialis, recurrent intraoral herpes)

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6
Q

How is the HSV-1 primary infection contracted?

A

occurs by contact with an infected person who is actively releasing the virus (majority of primary infections are asymptomatic)

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7
Q

socioeconomic status and age of infection of HSV-1

A

Developing countries: 50% by age 5, 100% by age 30

Developed countries: 20% by age 5, 50-60% by adulthood

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8
Q

2 systemic primary infections of HSV-1

A
  • acute herpetic gingivostomatitis

- pharyngotonsillitis (less common, adults, tonsils and pharynx only)

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9
Q
  • most common type of symptomatic primary HSV-1 infection
  • most cases develop between 6 months-5 years of age
  • newborns are protected by maternal antibodies
  • can be seen in teenagers and adults too
A

acute herpetic gingivostomatitis

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10
Q

peak prevalence of acute herpetic gingivostomatitis

A

2-3 years of age

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11
Q

clinical features: cervical lymphadenopathy, fever, chills, nausea, anorexia, painful oral lesions, abrupt onset

A

acute herpetic gingivostomatitis

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12
Q

Name the disease that these oral lesions describe:

  • both moveable and attached mucosa affected
  • numerous, tiny vesicles that rapidly rupture and coalesce to form larger areas of ulceration
  • gingiva becomes enlarged, painful, and intensely erythematous
  • erosion/ulceration is especially common at the free gingival margin
A

acute herpetic gingivotomatitis

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13
Q

occurs at areas supplied by the involved nerve ganglion (usually trigeminal)

A

recurrent HSV-1 infection

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14
Q

Most common site of recurrence of HSV-1?

Recurrences can also affect?

A
  • vermillion border and perioral skin is the most common site of recurrence (herpes labialis)
  • recurrences can also affect the oral mucosa (recurrent intraoral herpes)
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15
Q

aka “cold sores” or “fever blisters”, 15-45% of the US population has a history of this

A

herpes labialis

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16
Q

Potential triggers for herpes labialis:

A
  • exposure to UV light (only one experimentally proven)
  • physical or emotional stress
  • trauma (including manipulation of tissues during dental procedures)
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17
Q
  • characteristic prodrome 6-24 hours before clinical lesions develop (pain, burning, tingling, itching, erythema)
  • clusters of fluid-filled vesicles form, rupture, and crust within 2 days
  • mechanical rupture of intact vesicles can result in spreading of the virus
A

herpes labialis

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18
Q

recurrent intraoral herpes: involvement is limited to what parts of the mouth

A

keratinized, attached mucosa (attached gingiva, hard palate)

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19
Q

a cluster of tiny vesicles that quickly rupture to form shallow erosions and ulcers

A

recurrent intraoral herpes

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20
Q

HSV-1 infection of the thumbs and fingers, can occur through self-inoculation by a young patient who has primary herpes

A

herpetic whitlow

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21
Q
  • before routine use of gloves, medical and dental professionals were commonly affected due to contact with infected patients
  • recurrences on the fingers are common and can cause paresthesia and scarring
A

herpetic whitlow

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22
Q

Diagnosis of?

  • clinical presentation is often characteristic
  • exfoliative cytology or biopsy
A

HSV-1

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23
Q

In HSV-1, infected epithelial cells become ______ (detached from each other –> _____ cells)

A

acantholytic / Tzank cells

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24
Q

histo: enlarged and multinucleated epithelial cells

A

HSV-1

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25
Q

tx for HSV-1

A

antiviral meds, restrict contact with others, postpone dental treatment until resolved, pall

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26
Q

palliative care for HSV-1

A
  • adequate hydration and nutrition
  • tylenol or ibuprofen
  • viscous lidocaine (adults only)
  • dyclonine HCl 0.5-1% (kids)
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27
Q

treating acute herpetic gingivostomatitis (children)

A

acyclovir suspension (within first 3 days)

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28
Q

treating primary OR recurrent HSV-1 (adults and kids over 12)

A

valacyclovir (valtrex) 1 g caplets, initiate treatment during the prodrome or as early as possible in the course of the infection

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29
Q

topical cream (penciclovir 1% cream), start during prodrome

A

treating herpes labialis

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30
Q

HHV-3

A

varicella zoster virus (VZV)

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31
Q

How is VZV spread?

A

air droplets or direct contact with active lesions

32
Q

primary vs recurrent VZV infection

A

Primary = varicella (chickenpox)

Recurrent = herpes zoster (shingles)

33
Q
  • primary VZV infection
  • non-immunized patients
  • clinical features: sore throat, runny nose, fever, characteristic itchy rash
A

chickenpox

34
Q

distribution of lesions during chickenpox

A

skin lesions begin first on the face and trunk, then spread to the extremities

35
Q

progression of each lesion with chickenpox

A

erythema –> vesicle –> pustule –> crust/scab

36
Q

vesicle stage of chickenpox looks like this

A

“a dewdrop on a rose petal”

37
Q

Potential complications of varicella (chickenpox) in children vs adults

A

Children

  • skin infections
  • encephalitis
  • pneumonia

Adults

  • occur more often than in kids
  • most common and most serious = pneumonia
38
Q

Those infected with varicella (chickenpox) are contagious from when to when?

A

from 2 days before the rash until all lesions have crusted

39
Q

vaccination against varicella (chickenpox)

A

MMRV (2 doses: first at 12-15 months, second at age 4-6 years)

40
Q

After the primary infection, VZV establishes latency where? What happens when VZV is reactivated?

A

nerves / herpes zoster (shingles)

41
Q

involves the skin distribution of the affected sensory nerve (dermatome), affects 1 in 3 individuals during their lifetime, can occur more than once, incidence increases dramatically after age 50

A

herpes zoster (shingles)

42
Q

3 phases of herpes zoster (shingles)

A

prodrome, acute, chronic

43
Q

Name the phase of herpes zoster (shingles):

  • Precedes the skin rash by 1-4 days
  • Present in over 90% of cases
  • PAIN in the area of skin innervated by the affected dermatome
  • Thoracic dermatomes are affected in about 2/3s of cases
A

prodrome phase

44
Q

Name the phase of herpes zoster (shingles):

  • Affected skin develops clusters of vesicles with surrounding erythema
  • Vesicles collapse and form crusts
  • Lesions terminate at the midline!
  • If the trigeminal nerve is affected, oral lesions can occur (usually the overlying skin is also involved)
  • Resolves in 2-3 weeks
A

acute phase

45
Q

Name the phase of herpes zoster (shingles):

  • Characterized by postherpetic neuralgia
  • Pain that persists more than 90 days after rash onset
  • Rare in patients under age 40
  • Affects at least 10-15% of patients over age 60
  • Older adults are more likely to have severe and longer-lasting pain
A

chronic phase

46
Q

vaccine against herpes zoster (singles) recommended for all people > 50 yo

A

shingrix vaccine

47
Q

ocular involvement can cause blindness (what is the hint that an ocular infection exists?)

A

herpes zoster (shingles)

*Hint: if the tip of the nose is has lesions, V1 (ophthalmic division) is affected and the potential for ocular infection exists, referral to an opthalmologist is mandatory!

48
Q

usually the worst aspect of a herpes zoster (shingles) infection and also the most difficult to successfully treat

A

postherpetic neuralgia

49
Q

HHV-4

A

Epstein-Barr virus (EBV)

50
Q
  • Exposure during childhood is usually asymptomatic
  • Most symptomatic primary infections occur in young adults (infectious mononucleosis)
  • Symptomatic primary infection = Spread through contaminated saliva, intimate contact (“kissing disease”)
A

EBV

51
Q

Where does EBV remain latent?

A

B lymphocytes

52
Q

exposure of EBV in developing nations vs US

A

Developing: exposure usually occurs by age 3 (universal by adolescence)

US: exposure is delayed, 50% of entering college students are unexposed

53
Q

EBV is also implicated in other diseases besides mononucleosis:

A
  • oral hairy leukoplakia
  • some lymphomas (especially Burkitt lymphoma)
  • nasopharyngeal carcinoma
54
Q

Clinical features:

  • Prodrome of fatigue, malaise, anorexia (may precede other symptoms below by 2 weeks)
  • Fever
  • Pharyngitis
  • Cervical lymphadenopathy (bilateral) –> occurs in over 90% of cases
  • Hepatosplenomegaly
  • Tonsillitis (diffuse surface exudate)
  • Enlargement of both pharyngeal and lingual tonsils
  • Palatal petechiae (present in 25% of cases)
  • Necrotizing ulcerative gingivitis
A

mononucleosis

55
Q

HHV-5

A

cytomegalovirus (CMV)

56
Q

90% of primary infections (at any age) are asymptomatic

A

CMV

57
Q

Where does CMV become latent?

A

After the primary infection, CMV can become latent in salivary gland cells, endothelium, macrophages, and lymphocytes.

58
Q

Seroprevalence in U.S. population = 50% for individuals 6-49 years old

A

CMV

59
Q
  • Infants can become infected through the placenta, during delivery, or during nursing
  • Another transmission peak occurs during adolescence (exchange of body fluids)
A

CMV

60
Q

symptomatic infections are usually limited to newborns and immunosuppressed patients

A

CMV

61
Q

Immunosuppressed patients affected by CMV:

A
  • transplant patients

- AIDS patients (CMV chorioretinitis, CMV colitis)

62
Q

histo: “owl eye” appearance

A

CMV

63
Q
  • RNA viruses associated with several diseases (coxsackieviruses A & B, echoviruses, poliovirus)
  • Routes of transmission: fecal-oral (ingestion), saliva, respiratory droplets
  • Very common (10-15 million infections/year in U.S.)
  • Epidemics that affect children ages 1-4
A

enteroviruses

64
Q
  • Usually caused by one of the coxsackieviruses

- Most cases are mild and resolve within 1 week

A

herpangina

65
Q

Clinical features:

  • fever
  • sore throat
  • dysphagia
  • a small amount (< 10) vesicles develop on the soft palate and tonsillar pillars, then rapidly ulcerate
A

herpangina

66
Q

usually coxsackievirus A16

A

Hand-Foot-and-Mouth Disease

67
Q

Clinical features:

  • Fever, flu-like symptoms
  • Oral lesions precede the development of skin lesions (may develop anywhere intraorally, variable in #)
  • Individual vesicles that rupture to form ulcers
  • Skin lesions: hands, feet, fingers and toes (red macules that develop central vesicles, may heal without crusting)
A

hand-foot-and-mouth disease

68
Q
  • Spread through respiratory droplets
  • Highly contagious
  • Pre-vaccine era (1963): >90% infected in U.S. by age 15
  • Was declared “eliminated” from U.S. in 2000
  • Still common in other countries
  • Has made a comeback in the U.S. among unvaccinated individuals
  • The MMRV vaccine is 99% effective
A

measles (rubeola)

69
Q

Name the stage of measles infection: fever, cough, runny nose, conjunctivitis, Koplik’s spots (oral cavity)

A

first stage

70
Q
  • Areas of erythema with numerous small, blue/white macules (“grains of salt”)
  • Buccal and labial mucosa, soft palate
A

Koplik’s spots (measles)

71
Q

Name the stage of measles infection: fever continues, diffuse erythematous maculopapular skin rash “morbilliform”

A

measles

72
Q

Name the stage of measles infection: fever ends, rash fades then desquamates

A

third stage

73
Q

complications from measles

A

common in up to 40% of cases –> pneumonia, encephalitis (1 in 5 require hospitalization)

74
Q
  • Swelling and inflammation of exocrine glands
  • Salivary glands are the best known site of involvement
  • Spreads through urine, saliva, and respiratory droplets
  • Epidemiology significantly affected by vaccination (88% effective)
  • Epidemics that usually occur among adolescents and young adults
  • 30% of cases are asymptomatic
A

mumps

75
Q
  • Rapid testicular swelling, pain, and tenderness
  • Usually unilateral
  • Affects 25% of post-pubertal males
A

orchitis (associated with mumps)

Oral Pathology Exam 1 (16 decks)

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